File No. 32977

This rule was published in the October 1, 2009, issue (Vol. 2009, No. 19) of the Utah State Bulletin.

Health, Health Care Financing, Coverage and Reimbursement Policy

Section R414-31-3

Program Access Requirements

Notice of Proposed Rule

(Amendment)

DAR File No.: 32977
Filed: 09/15/2009 03:26:04 PM

RULE ANALYSIS

Purpose of the rule or reason for the change:

The purpose of this change is to clarify physician certification requirements for inpatient psychiatric services.

Summary of the rule or change:

This change removes the word "or" to clarify that a physician must certify a recipient's need for inpatient treatment under the direction of a physician.

State statutory or constitutional authorization for this rule:

Section 26-1-5

Section 26-18-3

Anticipated cost or savings to:

the state budget:

There is no impact to the state budget because this change only clarifies ongoing certification requirements for inpatient psychiatric services.

local governments:

There is no impact to local governments because they do not fund or provide psychiatric services for Medicaid clients.

small businesses:

There is no impact to small businesses because this change only clarifies ongoing certification requirements for inpatient psychiatric services.

persons other than small businesses, businesses, or local governmental entities:

There is no impact to persons other than small businesses, businesses, or local government entities because this change only clarifies ongoing certification requirements for inpatient psychiatric services.

Compliance costs for affected persons:

There are no compliance costs to a single person or entity because this change only clarifies ongoing certification requirements for inpatient psychiatric services.

Comments by the department head on the fiscal impact the rule may have on businesses:

There should be no fiscal impact. Physician certification for this service has always been required and the rule change does not change that requirement.

David N. Sundwall, MD, Executive Director

The full text of this rule may be inspected, during regular business hours, at the Division of Administrative Rules, or at:

RULE TEXT

(1) Before admission for inpatient
psychiatric services or before authorization for Medicaid payment,
a facility physician must make a medical evaluation of the
recipient's need for care in the hospital and certify that
inpatient services are needed.

(2) The certification must document
that:

(a) ambulatory care resources available in
the community do not meet the treatment needs of the recipient;

(b) proper treatment of the
recipient's psychiatric condition requires services on an
inpatient basis [or ]under the direction of a physician; and

(c) the services can reasonably be
expected to improve the recipient's condition or prevent
further regression so that services will no longer be needed.

(3) The Bureau of Health Facility
Licensing, Certification and Resident Assessment, within the
Division of Health Systems Improvement, under the Department of
Health, reviews the medical evaluation and certification and
determines that the client meets certification of need
requirements.

KEY: Medicaid

Date of Enactment or Last Substantive Amendment: [
June 15, 2005
]
2009

Notice of Continuation: October 6,
2004

Authorizing, and Implemented or
Interpreted Law: 26-1-5; 26-18-3

Additional Information

The Portable Document Format (PDF) version of the Bulletin is the official version. The PDF version of this issue is available at http://www.rules.utah.gov/publicat/bull-pdf/2009/b20091001.pdf. The HTML edition of the Bulletin is a convenience copy. Any discrepancy between the PDF version and HTML version is resolved in favor of the PDF version.

Text to be deleted is struck through and surrounded by brackets (e.g., [example]). Text to be added is underlined (e.g., example). Older browsers may not depict some or any of these attributes on the screen or when the document is printed.

For questions regarding the content or application of this rule, please contact Craig Devashrayee at the above address, by phone at 801-538-6641, by FAX at 801-538-6099, or by Internet E-mail at cdevashrayee@utah.gov.